Shining the torch into the corners of homeopathy can often reveal some hidden features. Sometimes there are cobwebs in abundance. In this instance, Robert Medhurst, in his new and mammoth repertory takes on one of the largest contemporary issues the profession faces; accuracy and reliability of our most basic tool. You see, we can’t have it both ways. When asked, homeopaths say and teach that homeopathy is the application of the law of similars, yet they often ignore that fact when prescribing, basing prescriptions on all sorts of other strategies –the constitution, sensation, essence, miasm or whatever. Further, they choose to ignore the fact that the information that comes from so many of the provings that informs that law of similars is deeply flawed.

In his book The Concordant Clinical Homeopathic Repertory, Medhurst sets out to solve this problem of flawed proving data making its way into our textbooks by creating a reliable tool based on clinical confirmation, rather than the more speculative voice of the prover. In this instance, it’s statistics and evidence that matter. After all, when a remedy can be demonstrated over a long period of time to be useful in a significant way and that can be measured, does that not count for as much, if not more, than the proving information? As a natural result of that line of thinking, this repertory explores the world of clinical confirmation.

Robert Medhurst is well known to virtually every student, graduate and practitioner of homeopathic medicine in Australia. For years contributing to the Journal of the ATMS (Australian Traditional Therapists Association, Australia’s leading natural therapists association), collating homeopathy research information and disseminating it, he has also produced the pivotal work describing and discussing the pragmatic realities of running a natural medicine practice in the book, The Business of Healing. It’s compulsory reading, and not just for natural medicine practitioners in Australia but world-wide. Now he has turned his attention to the most technical part of homoeopathy, the repertory.

Given the fact that there are upwards of 120 repertories in homeopathy according to Julian Winston in The Heritage of Homeopathic Literature, it is surprising that not a lot has been written about the use of them. Of course nowadays some practitioners don’t even bother using them at all. But jobbing homeopaths do. Why this is important is because, if they are fundamental tools used in everyday practice for most homoeopaths, then there does need to be a robust dialogue about some important questions:

With what intent were they written?

What is their purpose?

Is the information in them reliable?

Hahnemann’s hand-written unpublished Symptomenlexicon was the first in 1817. For his own use only, it was an index of the contents of Materia Medica Pura and The Chronic Diseases, and represented the simple language of the participants of his provings from the early 1800’s. It was a simple solution to a big problem. With a proving generating upwards of 1000 pieces of useful information, the more provings that were conducted, the harder it became to manage that information. His solution was a very useful private information management system. We have the same drama today as a consequence of the Internet, but on a herculean scale. Too much information. Information nowadays needs to be curated and managed. You cannot drink from the fire hose.

Jahr was the first to wrestle with the issue with the intent to publish a repertory. His Manual, published in 1834, came out at a similar time as Hering, who by this time in America, was working on his attempt at cross-referencing symptoms. But it was Böenninghausen who published first. A lawyer and taxonomist by training and disposition, his work, first published in 1832, went through many revisions to emerge as the 1846 Therapeutic Pocketbook. These attempts at creating order from a mountain of information had two clear yet different threads. A fundamental understanding of Böenninghausen was that the characterising dimensions of symptoms were not limited to single symptoms but ran through the remedy profile. As a consequence, sensations and modalities such as ‘cutting’, or ‘worse before breakfast’, could safely be considered important features of the remedy and thus not limited to just the particular, but to the general as well. Hering and Jahr’s interpretation was different on the other hand; perhaps more literal. The two schools created different textbooks, from different perspectives, requiring different skills, sometimes leading to different results, and sometimes similar results as each other. In fact the history of homeopathy in the 1800’s is littered with other attempts at creating repertory. It is estimated that by 1900 there were about 75 that been published; Knerr, Gentry, Guernsey to name but a few. But it was Kent whose work, based on the previous work of Hering and Jahr, emerged out of the scrum to dominate homeopathic analysis for another century. Later there were card repertories, additions to the repertory, and in the revival of homeopathy towards the end of the 20th century, works by vanZandvoort, Schroyens and Murphy. Combining homeopathic skill with an understanding of software led to searchable electronic versions; Isis, Radar and MacRepertory, and soon with more sophisticated work, the ability to generate a more modern Böenninghausen-style approach with Repertorium Universal. It’s been quite a journey. But often forgotten is a third way, the clinical repertory.

Of course homeopaths learn how to use the repertory well, whichever one they choose to use. But what we know for sure is that virtually no homeopaths have ever read the introduction to the repertory they use! This matters, because it is in the introduction to every repertory that we find the philosophy and underpinning understanding of the information therein. Van Zandvoort (2007) for example has a completely opposing understanding from Schroyens (2001) when it comes to choosing reliable information. A superficial use of both of these repertories would reveal that most entries are similar but significantly, many are not.

But what about its relevance and reliability? The best article written on repertory in recent times is Gadd’s, In search of Reliable Repertory (2009), published in Homeopathy. He describes how repertory provides a link between the facts of the case and materia medica, and is crucial in the process of narrowing the choice of remedies before prescribing.

Gadd argues that the reliability and validity of the information on homeopathic repertory has to be addressed because the information upon which it is based, both provings and clinical confirmation, have rubbery foundations. In repertories there are issues with poor referencing practices, straight up omissions, typos, poor translating of symptoms to rubrics, poor translation from one language to another, misunderstanding of the true context of symptoms and a complete misunderstanding over additions and gradings (Rutton 2008, Dimitriadis 2004). Expert technicians of homeopathy are not often expert academics. Expert opinion has not necessarily been accompanied by expert listening and discriminating as to whether the opinion has any validity or not. Gadd gives a litany of examples from the literature. Medhurst, in the introduction to his Concordant repertory, also gives a couple of examples of straight up poor practice and unreliable information. In doing so, he sets up the problem, and then he fixes it. He argues that proving data is often unreliable –it only constitutes a part of what goes into understanding a materia medica remedy profile and thus a simillimum. The way Medhurst has tackled this problem has been to create an index of concordance. This is an accumulation of suggested remedies as agreed by a number of authors. This book is thus an accumulation of expert opinion, ordered by disease and condition.

I have no doubt that this book (and the subsequent software package – please please make this available electronically) will continue to be a live document that will be added to. We could have a discussion about whose expert opinion got in and whose didn’t – who ‘made the cut’ – but actually at the end of the day it doesn’t matter. There are 28 experts chosen by Medhurst from the origins of homeopathy to the present.

The value of his approach has been that it cuts through the dross. The challenges of the repertories mentioned above notwithstanding, for many, we are time poor. In this evidenced based world in which we live, lectures that used to be two hours are now chunked into 20 minute learning windows, as that is the attention span of the modern student.

There is apparently something called Twenty 20 cricket. Many patients don’t have time for the 90 minute consultations. Many busy homeopaths choose to use a different business model. This is especially the case in countries such as India, Malaysia, Brazil and Germany. Keynote prescribing can be a solution to those with large waiting rooms full of anxious clients. This repertory will be gold for those homeopaths working with a lot of clients, that need a sharp reliable tool based on measurable results and evidence.

In a way this is advanced work. There may be pitfalls. To the uninitiated, superficially, it could look like the homeopaths role is to look up the name of the disease and there’s a list of remedies. It avoids traditional homeopathic work entirely. Some might throw up their hands in horror and have an opinion.

But wait. Have you been to a LIGA conference recently? Where are the young doctors being attracted to the profession? Have you looked at numbers of students at homeopathic colleges around the world? Programs are closing not opening. Using an evidence informed tool such as Medhurst’s book with really appropriate training could be a way to regenerate the profession.

The details of the book are 920 pages and it’s heavy.

References

Dam, K. (1996) The mind of the repertory: how to improve the repertory. Homoeopathic Links; 9(1): 18-23

About the author

Alastair Gray

Alastair Gray MSc (UK) ADH (NZ) RSHom (UK) DSH (UK) PCH (UK) PCHom (Malay) BAHons (NZ) Alastair Gray was originally educated as an historian; the ultimate study and analysis of change over time. For the last 20 years he has been pivotal in implementing change in people’s lives through the use of natural medicine. His work as a practitioner, educator, lecturer and writer in natural medicine is acknowledged world-wide. His website is http://grayhomeopathy.com/

5 Comments

Interesting article. It may be born in mind, that Hahnemann came off the idea of the symptomenlexikon after 3 attempts failed. Btw. the information contained in the original symptomenlexikon comes from secondary sources, not directly from the provings. ( I inspected those volumes myself in the archive)

also- it needs to be highlightend, that all later American repertories bootlegged Boenninghausen’s SRH and TT. Kents repertory already contains 3 sources all taking from the Tt.

Kent took great liberties in changing gradings, omitting remedies and changing rubric titles.. The cumulative effect is, that it is very unreliable, reflected also by the amount of corrections every year.

here the Kent repertory published by Ramptal L. Patel should be mentioned, as it is the first sensible effort to bring some order into this monumental work.

Boenninghausen himself based the repertory on his work: Eigentuemlichkeiten und Hauptwirkungen (pecularities and main spheres of action ) adding less important proving symptoms in lower grades.

Boenninghausen published some of the results of his work in repertories and materia medicas, but never published the exact plan they are based on.

So– without knowing the exact plan, but using Boe’s repertories as references, it is and was impossible to make meaningful alterations or additions to it. without compromising the reliability.

This was realized by Boger — so he published the most authentic repertory based on boenninghausen’s works in his repertory BB1 (1905) This contains some additions earmarked from himself.

I cannot see, how 20 random authorities without having shown to have the key of entering / changing such a repertory can be trusted in making this work anymore reliable than any other previously published one.

It could be more reliable, simply because it culls conflations from more highly regarded homeopaths, esp modern ones. Phataks concise, bogers synoptic key and sankarans pocket rep are also based on what has worked in clinic. But your point about compounding errors from 2nd hand boenninghausen sources Hans is well taken. Frankly I would love to see schools collaborate on reproving the classical materia medica with constitutions and potencies noted from get go, the proving a themselves are often, especially Hahnemann’s, not even done with remedies in potency, but mother tinctures no?